Healthcare Provider Details

I. General information

NPI: 1427392646
Provider Name (Legal Business Name): DILLEY AMBULANCE SERVICE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2012
Last Update Date: 11/15/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 W MILLER ST
DILLEY TX
78017-3819
US

IV. Provider business mailing address

211 W MILLER ST
DILLEY TX
78017-3819
US

V. Phone/Fax

Practice location:
  • Phone: 830-965-6891
  • Fax: 830-965-1769
Mailing address:
  • Phone: 830-965-6891
  • Fax: 830-965-1769

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number1000513
License Number StateTX

VIII. Authorized Official

Name: MS. JESSICA LINDA VILLANUEVA
Title or Position: OWNER
Credential:
Phone: 830-965-6891